What do ace inhibitors do
Pro Research Analysisby 
Searched over 200M research papers
Consensus Meter
Understanding the Role of ACE Inhibitors in Medical Treatment
Introduction to ACE Inhibitors
Angiotensin-converting enzyme (ACE) inhibitors are a class of medications primarily used to treat cardiovascular and renal diseases. They work by inhibiting the enzyme responsible for converting angiotensin I to angiotensin II, a potent vasoconstrictor that also promotes salt retention and hypertrophy. By blocking this conversion, ACE inhibitors help restore the balance between angiotensin II and bradykinin, a vasodilatory and natriuretic peptide .
Mechanisms of Action
Vasodilation and Natriuresis
ACE inhibitors decrease systemic vascular resistance without increasing heart rate, promoting vasodilation and natriuresis. This makes them effective in treating hypertension and reducing mortality in conditions like congestive heart failure and left ventricular dysfunction post-myocardial infarction .
Metabolic Effects
In insulin-resistant conditions, ACE inhibitors enhance glucose uptake in skeletal muscle by increasing nitric oxide production through bradykinin B2 receptors and reducing the inhibitory effects of angiotensin II on glucose transport. This results in improved insulin signaling and glucose metabolism, making ACE inhibitors beneficial for hypertensive type 2 diabetic patients .
Cardioprotective and Renoprotective Effects
ACE inhibitors have been shown to reduce cardiovascular events, such as myocardial infarction and stroke, and delay the progression of diabetic nephropathy. They also stabilize plaques and inhibit ischemic events, contributing to their cardioprotective and renoprotective roles .
Clinical Applications
Hypertension and Heart Failure
ACE inhibitors are widely used as first-line therapy for hypertension and heart failure. They reduce blood pressure by decreasing angiotensin II levels, which in turn reduces vasoconstriction and salt retention . In heart failure, they prevent the progression of left ventricular dysfunction and reduce mortality .
Diabetes and Metabolic Syndrome
In patients with diabetes, ACE inhibitors improve insulin sensitivity and glucose metabolism, reducing both microvascular and macrovascular complications. They also lower the incidence of type 2 diabetes in individuals with essential hypertension.
Coronary Artery Disease
While ACE inhibitors are beneficial in hypertensive patients with coronary artery disease (CAD), their effects in normotensive patients with CAD are inconsistent. They may reduce myocardial ischemia in hypertensive patients but can sometimes worsen angina in normotensive patients due to lowered coronary perfusion pressure .
Natural ACE Inhibitors
There is growing interest in natural ACE inhibitors derived from plants, which may offer fewer side effects compared to synthetic drugs. Various plant species and their bioactive metabolites, such as peptides, phenolics, flavonoids, terpenoids, and alkaloids, have shown significant ACE-inhibitory activity. These natural compounds also possess antioxidant, antidiabetic, antihyperlipidemic, and anti-inflammatory properties, making them promising candidates for developing new antihypertensive drugs.
Conclusion
ACE inhibitors play a crucial role in managing cardiovascular and renal diseases by promoting vasodilation, natriuresis, and improving metabolic control. They are effective in treating hypertension, heart failure, and diabetes-related complications, and ongoing research continues to explore their full therapeutic potential. Natural ACE inhibitors from plants also present a promising avenue for future drug development.
Sources and full results
Most relevant research papers on this topic